1450 - Effect of high-frequency transcutaneous electrical nerve stimulation combined with task-specific training on upper limb functions in stroke patients: A single-blinded randomized controlled trial.
Associated Professor Chulalongkorn hospital Bangkok, Krung Thep, Thailand
Objectives: To investigate the functional and impairment efficacies of transcutaneous electrical stimulation (TENS) combined with task-specified exercise compared with task-specific only on upper limb function in subacute stroke.
Design: Randomized single-blinded clinical trial
Results: TENS combined task-specific exercise induced greater and earlier improvement in FMA-UE, ARAT, BBT, Barthel index, and MAS than task-specific exercise only in 2 weeks after treatment. Although there were no between-group differences in all outcome measures, both treatments demonstrated significant improvements in FMA-UE, ARAT, BBT, and Barthel index after training for 2 weeks, 4 weeks, and a follow-up for 1 month.
Conclusions: The combination of Transcutaneous Electrical Nerve Stimulation (TENS) and Task-specific training appears to be more effective than Task-specific training alone in facilitating early two-week motor recovery and subsequently slowly enhancing the rate of the upper extremity in subacute stroke. Moreover, this protocol utilizes telerehabilitation, which proves to be advantageous in adapting to the post-pandemic “new normal” situation.
Scientific Paper Best Paper Award Abstract:
Objective: To investigate the functional and impairment efficacies of transcutaneous electrical stimulation (TENS) combined with task-specified exercise compared with task-specific only on upper limb function in subacute stroke. Design: Randomized single-blinded clinical trial
Setting: Tertiary Care
Participants: 31 participants had a subacute stroke with unilateral weakness, and 27 completed the study.
Intervention: The intervention group (n= 16) received transcutaneous electrical stimulation for 30 mins combined with task-specific training for 40 mins, and the control group(n=15) received task-specific training for 40 mins only. They were trained by telerehabilitation supervision physical therapy and occupational therapy for 4 weeks.
Main Outcomes Measures: The primary outcome was the Fugl-Meyer Assessment of upper extremity (FMA-UE) and the secondary outcome was the Action Research Arm Test (ARAT), Box and Block Test (BBT), Modified Ashworth Scale, and Barthel ADL index. Assessment will be conducted before treatments (T0), immediately after treatment for 2 (T1) and 4 weeks (T2), and at the one-month follow-up (T3). Results: TENS combined task-specific exercise induced greater and earlier improvement in FMA-UE, ARAT, BBT, Barthel index, and MAS than task-specific exercise only in 2 weeks after treatment. Although there were no between-group differences in all outcome measures, both treatments demonstrated significant improvements in FMA-UE, ARAT, BBT, and Barthel index after training for 2 weeks, 4 weeks, and a follow-up for 1 month. The FMA-UE of the TENS group, mean (SD), was T0: 37.14(11.24), T1: 49.07(16.69), T2: 52.50(17.48), and T3: 54.38(15.59). The FMA-UE of the task-specific only group, mean (SD), was T0: 35.54(7.44), T1: 46.83(9.05), T2: 55.23(6.53), and T3: 55.37(12.60). The ARAT of the TENS group, mean (SD), was T0: 16.93(18.84), T1: 29.86(22.47), T2: 36.50(22.41), and T3: 38.08(23.45). The ARAT of the task-specific only group, mean (SD), was T0: 9.54(10.73), T1: 18.00(18.10), T2: 28.61(19.86), and T3: 36.00(18.62). The BBT of the TENS group, mean (SD), was T0: 12.36(14.06), T1: 19.21(16.68), T2: 24.57(19.27), and T3: 25.54(19.39). The BBT of the task-specific only group, mean (SD), was T0: 6.61(8.71), T1: 14.08(10.47), T2: 20.38(13.46), and T3: 27.87(13.93). The Barthel ADL index of the TENS group, mean (SD), was T0: 64.29(26.59), T1: 84.29(17.85), T2: 92.86(9.55), and T3: 96.92(7.23). The Barthel ADL index of the task-specific only group, mean (SD), was T0: 66.15(22.56), T1: 80.00(20.89), T2: 88.46(16.63), and T3: 100(0). MAS of wrist flexion of the TENS group, mean (SD), was T0: 0.57(0.51), T1: 0.46(0.57), T2: 0.57(0.65), and T3: 0.42(0.57). MAS of wrist flexion of the task-specific only group, mean (SD), was T0: 0.46(0.63), T1: 0.54(0.72), T2: 0.56(0.68), and T3: 0.44(0.68). The interaction between time and group was significant results with the exception of the task-specific only group at follow-up post-intervention, and the difference between the groups was no significant results. Finally, MAS of elbow extension (Bicep) of the TENS group, mean (SD), was T0: 0.43(0.62), T1: 0.25(0.51), T2: 0.29(0.61), and T3: 0.23(0.60). MAS of the task-specific only group, mean (SD), was T0: 0.35(0.55), T1: 0.33(0.49), T2: 0.08(0.28), and T3: 0.06(0.18). The interaction between time and group and the difference between the groups were no significant results. Significance was set P value < 0.05.
Conclusions: The combination of Transcutaneous Electrical Nerve Stimulation (TENS) and Task-specific training appears to be more effective than Task-specific training alone in facilitating early two-week motor recovery and subsequently slowly enhancing the rate of the upper extremity in subacute stroke. Moreover, this protocol utilizes telerehabilitation, which proves to be advantageous in adapting to the post-pandemic “new normal” situation.
